SADC Ministers of Health met in Limpopo on Friday November 11th to commemorate SADC Malaria Day and raise the profile of the disease. The theme of this year’s event was, “Be free of Malaria in the SADC region,” which is now conceivable as several countries in the region move towards the goal of malaria elimination. But while some countries are making progress, the evidence from the region and around the world suggests that sustained elimination of the disease will require far higher economic growth and levels of prosperity. Though malaria control in southern Africa has largely been a good news story, it isn’t without controversy.
Spraying insecticides such as DDT inside houses has proved to be a highly successful strategy against the disease and is approved by the World Health Organization. Some fear however, without solid evidence, that the spraying could harm the environment and human health. Ministers of Health laid these fears to rest among the local population and sprayed the insides of houses themselves.
As part of the event members of the Mhlanga family at Bungeni village were visited by South Africa’s Minister of Health, Dr. Motsoaledi, and later said, “We will always remember Minister of Health Aaron Motsoaledi spraying DDT in our rooms. This will help in the fight against mosquitoes and malaria.” As part of the SADC Malaria Day events, an estimated 10,000 people from the surrounding communities descended on the sports field at Bungeni where they were entertained by the Mahuma drama group. Their short play highlighted the importance of being prepared for spray operators and allowing them inside to spray to provide protection from the deadly bites of mosquitoes infected with the malaria parasite.
In South Africa in 2010, there were 8,060 cases and 87 deaths compared to the 64,622 cases and 458 deaths reported in 2000. This represents an 87 per cent reduction in malaria cases and an 81 per cent decrease in malaria deaths during this ten year period. This is a huge achievement for South Africa as we have now reached at least one of the Millennium Development Goals that was set by the United Nations General Assembly in the year 2000.
At the events, Dr Motsoaledi explained that these results were achieved through “Robust implementation of the key strategies for controlling malaria. These include: Vector Control using Indoor Residual Spraying (IRS), personal protection, effective case management by the introduction of combination therapy, advocacy and community mobilisation, epidemic preparedness and response and surveillance and research.” More specifically Dr Motsoaledi noted, “I am committed to supporting the scale-up of surveillance efforts and maintaining high coverage rates of IRS with DDT, to making our malaria elimination goal a reality.”
Other ministers of health noted that there is strong political will amongst the SADC countries to fight this disease. However, politics alone will not overcome malaria. Technical interventions, such as spraying, can dramatically lower the incidence, but the only way to rid the continent of disease is to grow rich. Countries that have eradicated malaria did so with solid public health interventions, matched by policies that foster growth and prosperity. And the best way to achieve this growth is through increased levels of economic freedom – in the true sense of the term. Two islands in the SADC region provide interesting evidence. In the early 1970s Mauritius eliminated malaria and also adopted economic reforms that propelled the small island onto a path of sustained economic growth. Greater economic freedom and free trade made Mauritius and its inhabitants wealthier than at any time in their history.
That wealth has sustained malaria surveillance programmes and the consequence has been that no malaria outbreak of any significance has occurred in the past three decades. Since the 1960s, Zanzibar, on the other hand, has twice managed to bring malaria cases almost to zero. But on each occasion the disease made a rapid and deadly return because the country was unable to sustain its control programmes. And it was unable to sustain its programmes because of widespread poverty and policies that discourage trade, investment and wealth creation. Right now, thanks to donor aid programmes, the disease is once again almost eliminated. Whether it will finally be banished from the islands or will once again return remains to be seen.
Continued freedom from malaria is unlikely given the fact that almost 100% of the health budget is provided by donors and poverty remains endemic due to sluggish efforts to reform the economy. With ongoing funding and evidence-based programmes, the SADC region will probably continue to make progress against malaria. But seeing 10,000 people queuing for food at the SADC Malaria Day event revealed the stark reality that many of the people present could barely afford to sustain themselves, let alone undertake personal protective measures against the disease. So will it be possible to eliminate malaria? Yes, of course, one day it will be possible, but given the inadequate current and expected future levels of economic growth, elimination in SA (in the sense of zero transmission) seems unlikely to occur in our lifetime, especially if SA’s declining economic freedom trend continues.
By Jasson Urbach.
A director of Africa Fighting Malaria and of the Health Policy Unit.